青春期少女不同月经模式的生殖内分泌代谢调查研究

目的：探讨青春期少女不同月经模式的生殖内分泌代谢状态。方法：100例青春期月经异常的患者，按不同月经模式分为A、B、C3组，即月经稀发者38例（A组），继发闭经者26例（B组），功能性子宫出血者36例（C组）。32例正常月经、年龄相似的少女为对照组。对所有月经异常者E1服达英一35，伴胰岛素抵抗者加二甲双胍治疗。用放射免疫法测定血清促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E2）、睾酮（T）、雄烯二酮（A）、瘦素（1eptin）、空腹血糖（FEG）及空腹胰岛素（FINS）水平。同时测定胰岛素抵抗（IR）指数及体重指数（BMI）。结果：100例青春期月经异常患者性激素水平有不同程度的改变。其中LH/FSH、T、A、leptin水平显著高于对照组（P〈0．01），A、B组与c组A、leptin之间差异有统计学意义（P〈0．05），但T、LH/FSH各组之间差异无统计学意义（P〉0．05）。C组36例中有24例LH／FSH、T水平符合多囊卵巢综合征（PODS），占66．6％。所有月经异常患者中伴肥胖31例，占31％。FINS、leptin水平肥胖与非肥胖之间差异有统计学意义（P〈0．05），T、A水平差异无统计学意义（P〉0．05）；肥胖组IR指数及BMI均高于非肥胖组；IR指数、FINS、BMI比较差异均有统计学意义（P〈0．01）。经治疗后，各组血清T、LH／FSH、A、leptin、FINS水平较用药前显著下降（P〈0．01）。停药后均能自然行经3--8个月，治疗期间月经规则，月经量较治疗前增多，效果较显著。结论：青春期月经异常者性激素代谢改变多数与PCOS的特点相似，纠正高T、FINS及IR是恢复正常月经周期的关键。

Investigation of hormonal metabolism pattern associated with menstrual disorders in adolescent maiden

Objective:To investigate of hormonal metabolism pattern associated with menstrual dimmers in adolescent maiden with menstrual disorders.Methods:One-hundred adolescent maiden with various menstrual disorders were divided into three groups:group A (38 cases with oligomenorrhea),group B (28 cases with ,secondary amenorrhea),and group C (36 cases with dys- functional uterine bleeding).Age- matched control group inchuded 32 patients with regular menstruation.All menstrual disorder pa- tients took orally Diane 35 and patients accompanied with insulin resistance added biguanide again.The levels of FSH,LH,estradiol (E_2),testosterone (T),androstenedione (A) and leptin in serum as well as fasting insulin (FINS) were measured by radioimmunoas- say (RIA).At the same time,insulin resistance (IR) and body mass index (BMI) were tested.Results:The levels of LH/FSH,T, A and leptin in all menstrual disorder patients remarkably increased compared with those of the control group (P<0.01).Among the three disorder groups,the levels of A and leptin in group C were significandy lower than those in the other two (P<0.05).In group C,24 cases (66%) were diagnosed as poly cystic ovarian syndrome (PCOS) based on levels of LH/FSH and T.Among all menstrual disorder patients,31 cases (31%) were accompanied with obese.Significant differences were observed in the levels of FINS and lep- tin between obese and non-obese individuals (P<0.05),although their T and A levels were similar (P>0.05).IR and BMI were higher in obese group than in non-obese group.After treatment,all patients had a regular menstruations for 3 to 8 months,accom- partied with remarkably dropped T,LH/FSH,A,leptin and FINS levels (P<0.01),which were compared with those in the con- trol group(P>0.05).Conclusion:Alteration in hormonal metaholism such as high level of T,A,leptin or FINS in adolescent men- strual disorders is ,similar to that in PCOS.Therefore,to reduce T,insulin and IR level is critical in management of these disorders.